MEDICARE: DR. SIVA PRASANNA TADISETTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME94439	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77464773	OTHER	FL	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	31547	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1518988823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIVA PRASANNA TADISETTI M.D.

Provider Business Mailing Address
First Line	:	2995 DREW ST
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-315-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 WINDGUARD CIR
Second Line	:	STE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7353
Country	:	US
Telephone Number	:	813-333-3331
Fax Number	:	813-466-7482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/20/2023

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